Purpose
The aim of this study is to evaluate the therapeutic efficiency of the noninvasive corneal indentation (CI) procedure versus anterior chamber paracentesis (ACP) as an adjuvant to classic medical treatment in patients with acute primary angle-closure glaucoma (PACG).
Design
This was a prospective, interventional, comparative study.
Place
Ain-Shams university hospitals and Elmaghrabi eye institutes.
Patients and methods
We included 30 eyes of 30 patients who had an attack of acute PACG and presented to us within the first 24 h. All patients received mannitol infusion (20%, 300 ml) as the first line of treatment. CI using Posner gonioprism was applied in 10 eyes (group I), ACP was performed in 10 eyes (group II), and 10 patients received only medical treatment (group III). The severity of pain, intraocular pressure (IOP), best-corrected visual acuity, corneal edema, and pupil size were assessed at multiple time points. The waiting time for laser peripheral iridotomy (LPI) was recorded. All patients were followed up for a minimum of 6 weeks.
Results
Pain relief was achieved rapidly in group II, where IOP reduction was 31% (IOP was 22 ± 11.5 mmHg) and 64% (IOP was 19 ± 7.6 mmHg) at 30 min and 2 h of follow-up, respectively. The grade of corneal edema in group II was 0.8 ± 1.3 and 0.5 ± 0.5 at 30 min and 2 h, respectively, which was significantly lower compared with both group I and III (P < 0.005). This facilitated early LPI (6 ± 2 h) in group II. However, in terms of IOP and best-corrected visual acuity, all the groups showed the same results at 12 h.
Conclusion
CI is a noninvasive and easy adjuvant method of reducing elevated IOP in the setting of PACG; improves corneal clarity and enables LPI. ACP restores corneal clarity faster and would be the choice for selected patients for whom medical therapy is restricted. Medical therapy alone shows a delay in controlling acute PACG and is rather exhausting for the patient.